In December I was able to attend an National Academies of Sciences workshop about the importance of non-pharmacological strategies for pain management. After the workshop, it was as expected that panelists decided that more research was required. To my surprise some scientists also demanded urgent action regarding the method to treat lower back pain. They asked for doctors to integrate the evidence that we have already into the clinical setting and for policymakers to pass payments reforms that be supportive of such implementation; and for us all to take the changes to our culture that are needed to ensure that patients get access to the appropriate treatment from the right doctor at the right time.
Where did this response originate from? It is a result of the reality that lower back pain has been over-treated which has caused a major issue worse, and the need to rebalance incentives to encourage doctors to follow the latest research and treatment guidelines.
Any health issue can cause more disability or greater expenses than a low back discomfort, and frequently employed medical treatments often cause more harm than. Imaging isn’t always necessary to create a scientifically-based treatment plan. It can cause the catastrophizing of pain, and also result in unexpected results “rabbit hole.” The use of prescription medications can be beneficial for some patients in specific situations, but risk often outweigh advantages. As per the CDC more than 266,000 deaths throughout America between 1999 and 2020 were caused by prescription opioids. Non-steroidal anti-inflammatory medications (NSAIDs) may cause bleeding in the intestine, particularly for older people and are linked to higher rates of heart attack. Surgery and corticosteroids may result in temporary pain relief for some patients but the effects are rarely long-lasting nor are they more effective than alternatives that are less invasive.
In addition, a lot of these treatments and diagnostic methods including earlier imaging, surgical consultations corticosteroid injections, prescription opioids, and NSAIDs could increase the number of patients who go from chronic to acute pain.
The issue is not the absence of evidence. The CDC and the Veterans Health Administration, and the American College of Physicians (ACP) have published complete guidelines that are backed by solid and convergent evidence to support the treatment for low back pain. First-line treatments that are recommended include non-pharmacological methods including exercises, education and self-care alternatives, spinal manipulatives, acupuncture and massage. The ACP guidelines specifically call for clinicians and patients to look into non-pharmacological methods of treating lower back discomfort prior to attempting prescription drugs.
The issue is that we’re not implementing the research. There are many obstacles to widespread implementation of best practices. Health systems are hesitant to adapt, particularly in cases where the changes may cause harm to their financial interests. Orthopedic surgeons are regularly rated among the top health systems earners, earning around $3.3 million annually. Primary care doctors may not have been taught about non-pharmacological treatment options in medical school, but they’re often encountering patients with anxiety who are naturally seeking a reason for their suffering and a quick fixmedication, injection or even surgery.
Furthermore, there is an obvious disconnect between current policies for payment and the best practices for treating low back pain. Insurance companies provide a substantial reimbursement for prescription drugs as well as corticosteroid injections and surgeries. However both public and private insurers frequently place significant restrictions on the coverage of guideline-concordant treatments like chiropractic care as well as acupuncture and massage. This type of policy provides no incentive for practitioners and health systems to alter their practices.
If we’re looking for to see real change, it’s going require a whole team consisting of “committed people.”
Health systems are able to ensure that they have staff who’s practices are in line with guidelines. Payers can alter their policies in order to align payment with guidelines. Some health care organizations and insurance companies are taking steps towards the correct direction. Duke University Health System has created its Spine Health Program to offer an integrated, guidedline-concordant treatment to patients suffering from lower back pain. United Healthcare does not charge co-pays when patients see an chiropractor or physical therapist to treat back pain. back pain. Traditional Medicare recently introduced the treatment of acupuncture with a small amount of coverage.
We should also promote educational sessions for clinicians on the research concerning the proper diagnosis and treatment for lower back pain. We should be familiar with ACP Guidelines. ACP Guideline and read the amazing Lancet collection on lower back pain. It is possible to inform patients that MRIs could result in worse outcomes, and surgery is not always required and remind them that the ACP recommends using non-pharmacological treatment prior to prescribing medications. The most important thing is that we without warning, if there are no warning signs, avoid prescribing these procedures or tests unless clearly required after the patient has engaged in a complete course of evidence-based non-pharmacological therapy.
It isn’t difficult to see that the problem is systemic. U.S. healthcare system is founded on the notion that patients gain from getting medical attention. However, this is not always the case for those suffering from low back pain. By not taking the time to study the evidence, ignoring it, and over-medicating the condition and continuing to accept policies that encourage the wrong treatment that cause real harm to the people who depend on us to take care of the back pain patients.
Christine Goertz, DC PhD is a professor in research in musculoskeletal disorders in Duke University’s Duke Clinical Research Institute n Durham, North Carolina, vice chair for Implementation of Spine Health Innovations within the Department of Orthopaedic Surgery at Duke University, and core faculty members at Duke’s Duke Margolis Center for Health Policy.
We understand how important it is to choose a chiropractor that is right for you. It is our belief that educating our patients is a very important part of the success we see in our offices.